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'No Surprises Act' Shields WI Residents From Surprise Medical Bills

A 2020 report by the Kaiser Family Foundation found about seventy percent of lower-income adults couldn't afford an unexpected $500 medical bill.
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A 2020 report by the Kaiser Family Foundation found about seventy percent of lower-income adults couldn't afford an unexpected $500 medical bill.

Surprise medical bills are a serious concern for many Wisconsin families, but a newly-enacted federal law could protect folks from unexpected healthcare costs.

The "No Surprises Act" went into effect on January 1, and it grants residents protections from surprise medical bills issued by out-of-network healthcare providers.

Sarah Smith - director of public affairs with the Wisconsin Office of the Commissioner of Insurance - said surprise bills often come after patients receive emergency medical care, and first responders have to take them to the nearest hospital - which may not be in their network.

"And, of course, that was just a situation that was necessary to make sure you could get to the closest location and stabilize the patient as soon as possible," said Smith. "But it does, y'know, then create a situation where, while the patient is trying to recover, they're faced with a surprise medical bill they didn't expect."

Smith said there are other cases which can occur during routine medical procedures. Wisconsinites can challenge a surprise medical bill by filing a complaint with the OCI or the federal Department of Health and Human Services, or by appealing to their insurance company.

Smith said officials are largely relying on folks to advocate for themselves, and actively report unexpected bills. She explains that enforcing the law is complex, as each case is different and some will involve both federal and state agencies.

"We are working really hard to try to preempt complaints," said Smith. "We're trying to make sure this information is very accessible not just to consumers but to providers, healthcare providers, and to insurers."

A February 2020 report from the Kaiser Family Foundation found that about two-thirds of Americans were worried about not being able to afford a surprise medical bill. More than 40% of insured adults reported they wouldn't be able to afford a $500 surprise medical bill.

Jonah Chester is Wisconsin Public Radio's 2022-2023 Mike Simonson Memorial Investigative Reporting Fellow embedded in the Wisconsin Watch newsroom. He most recently worked at Public News Service, a national radio news service, where he covered Wisconsin, Illinois and Indiana. He previously produced the 6 O'Clock News at WORT 89.9 FM in Madison, where he won numerous awards from the Milwaukee Press Club and Wisconsin Broadcasters Association for his reporting on issues in Dane County and south-central Wisconsin.
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